Journal of Musculoskeletal Trauma

Surgical Treatment for Displaced Intra-Articular Calcaneal Fractures in Elderly Patients: Comparison of the Minimally Invasive Approach and Extensile Lateral Approach: Hong Ki Park, Jae Yoon Ko, Seung Kwan Lee, Jong Min Baik; J Korean Fract Soc 2019;32(3):135-142. Published online July 31, 2019; DOI: https://doi.org/10.12671/jkfs.2019.32.3.135

PURPOSE
As the functional demands for activities in elderly patients are increasing according to their life extension, the need for surgical treatment is also increasing in elderly patients with displaced intra-articular calcaneal fractures. In addition to the extensile lateral approach (ELA), which is a surgical procedure that showed good results on intra-articular calcaneal fractures, the minimally invasive approach (MIA) also showed an outstanding result. This study compared the radiological and clinical results of intraarticular calcaneus fractures in elderly patients in two groups: ELA and MIA.
MATERIALS AND METHODS
Thirty patients aged over 65 years with intra-articular calcaneus fractures, who could be followed-up more than 14 months, were included in this study. Thirteen patients of the MIA group and 17 patients of the ELA group were analyzed retrospectively using radiological and clinical assessments.
RESULTS
No significant difference in union time, posterior facet reduction accuracy, subtalar osteoarthritis frequency, Bohler angle, calcaneal width, American Orthopaedic Foot and Ankle Society score, visual analogue scale score, 36-item short form survey, and foot function index was observed between the two groups. The p-value of the average height of the calcaneus correction, average length of calcaneal correction, and average loss of correction length were <0.001, 0.005, and 0.015, respectively. The incidence of complications, including soft tissue necrosis and bone infection, were 23.1% in the ELA group and none in the MIA group.
CONCLUSION
The clinical outcomes were similar in the two groups. The degree of reduction of fracture showed a better result in the MIA group than the ELA group. Furthermore, there were no complications in the MIA group, whereas the ELA group showed some complications.

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Clinical and Radiological Outcomes of ‘Blocking Kirschner Wire Technique’ in Displaced Intra-Articular Calcaneal Fractures via the Extended Sinus Tarsi Approach
Jeong-Kil Lee, Chan Kang, Sang-Bum Kim, Gi-Soo Lee, Jung-Mo Hwang, Byung-Kuk An
Journal of the Korean Orthopaedic Association.2021; 56(3): 224. CrossRef

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Treatment of the Trimalleolar Fracture Using Posterolateral Approach: Minimum 2-year Follow Up Results: Gwang Chul Lee, Jun Young Lee, Sang Ho Ha, Jae Won You, Sang Hong Lee, Hong Moon Sohn, Ki Young Nam, Kwang Hyo Seo; J Korean Fract Soc 2011;24(4):328-334. Published online October 31, 2011; DOI: https://doi.org/10.12671/jkfs.2011.24.4.328

Abstract PDF

PURPOSE
To analyze the long term follow up results of treatment with posterolateral approach and to investigate its usefulness in the patients of trimalleolar fracture with posterior fragment which is above 25% of articular involvement.
MATERIALS AND METHODS
There were 34 cases of trimalleolar fracture in our hospital from May 2004 to April 2008. We investigated 20 patients who underwent operation with the posterolateral approach and over-2 years follow up cases. The mean follow up period was 34 (24~58) months. Preoperative posterior malleolar fragment involved above 25% of articular surface in all cases and displaced more than 2 mm in 11 cases. We analyzed the radiologic type of posterior malleolar fragments and evaluated the function and pain through AOFAS score and complications.
RESULTS
All cases showed primary union at mean 13.1 weeks. The complications are that partial ankylosis result of soft tissue contracture is seen in 2 cases (10%) and post-traumatic arthritis is seen in 1 cases (5%) and 17 cases (85%) of all patients are showed excellent AOFAS score.
CONCLUSION
The posterolateral approach is a valuable method because that it enables us to easily reduction and internal fixation of the posterior malleolus and lateral malleolus at one time and the results are satisfied for a long time follow up.

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Outcomes of Immediate Operative Treatment of Ankle Trimalleolar Open Fractures
Jun-Young Lee, Yong-Jin Cho, Sin-Wook Kang, Yung-Min Cho, Hyun-Bai Choi
Journal of Korean Foot and Ankle Society.2020; 24(1): 25. CrossRef

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A Comparison of Extensile Lateral Approach and Sinus Tarsi Approach for the Sanders Type II Calcaneal Fracture: Jeong Seok Moon, Woo Chun Lee; J Korean Fract Soc 2009;22(1):13-18. Published online January 31, 2009; DOI: https://doi.org/10.12671/jkfs.2009.22.1.13

Abstract PDF

PURPOSE
To compare the clinical results between the extensile lateral approach and sinus tarsi approach in the open reduction of the Sanders type II calcaneal fracture.
MATERIALS AND METHODS
From July 2002 to Februry 2007, thirty two patients having thirty three calcaneal fractures of Sanders type II were managed with open reduction and internal fixation using the extensile lateral approach or sinus tarsi approach. The mean age of 19 patients using extensile lateral approach was 43.3 years. The mean age of 13 patients using sinus tarsi approach was 46.3 years. Clinical outcome, radiographic parameters, and postoperative complications were compared between both groups.
RESULTS
There was no difference between two groups associated with patients demographs. The mean AOFAS score and VAS between both groups were not different (p=0.716, p=0.774). The mean Bohler's angle and Gissane's angle between both groups were not different (p=0.343, p=0.357). Two cases of sural nerve injury, one malunion, and one deep infection were occurred in the group of extensile lateral approach. However, patients using sinus tarsi approach had no postoperative complications.
CONCLUSION
The clinical results of sinus tarsi approach may be comparable with those of extensile lateral approach, with the advantages of reduced risk of postoperative complications.

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The Extensile Lateral Approach to the Calcaneus
Rohan Bhimani, Kush C. Shah, Rishin J. Kadakia
Techniques in Foot & Ankle Surgery.2025;[Epub] CrossRef
Extensile lateral versus sinus tarsi approach for calcaneal fractures
Chuangang Peng, Baoming Yuan, Wenlai Guo, Na Li, Heng Tian
Medicine.2021; 100(31): e26717. CrossRef
Lateral Extensile Approach Versus Minimal Incision Approach for Open Reduction and Internal Fixation of Displaced Intra-articular Calcaneal Fractures: A Meta-analysis
Andrea Seat, Christopher Seat
The Journal of Foot and Ankle Surgery.2020; 59(2): 356. CrossRef
Surgical Treatment of Calcaneal Fractures of Sanders Type II and III by A Minimally Invasive Technique with 6.5 mm Cancellous Screw
Yong Seung Oh, Kyung Ho Lee, Jung Ho Kim, Myoung Jin Lee
Journal of Korean Foot and Ankle Society.2019; 23(3): 116. CrossRef
A systematic review and meta-analysis of the sinus tarsi and extended lateral approach in the operative treatment of displaced intra-articular calcaneal fractures
Tomasz L. Nosewicz, Siem A. Dingemans, Manouk Backes, Jan S.K. Luitse, J. Carel Goslings, Tim Schepers
Foot and Ankle Surgery.2019; 25(5): 580. CrossRef
Meta‐analysis of two surgical approaches for calcaneal fractures: sinus tarsi versus extensile lateral approach
Fei Zhang, Hongtao Tian, Shilun Li, Bo Liu, Tianhua Dong, Yanbin Zhu, Yingze Zhang
ANZ Journal of Surgery.2017; 87(3): 126. CrossRef
Usefulness of Treatment with 6.5 mm Cancellous Screw and Steinmann Pin Fixation for Calcaneal Joint Depression Fracture
Gi-Soo Lee, Chan Kang, Deuk-Soo Hwang, Chang-Kyun Noh, Gi-Young Lee
Journal of Korean Foot and Ankle Society.2015; 19(1): 11. CrossRef
Open reduction and internal fixation with conventional plate via L-shaped lateral approach versus internal fixation with percutaneous plate via a sinus tarsi approach for calcaneal fractures – A randomized controlled trial
Shengli Xia, Yaogang Lu, Huizhong Wang, Zuming Wu, Ziping Wang
International Journal of Surgery.2014; 12(5): 475. CrossRef
Intra-articular Calcaneal Fractures Treated with Open Reduction and Internal Fixation -A Comparative Study between Groups with and without Bone Graft-
Hong Moon Sohn, Sang Ho Ha, Jun Young Lee, Sung Hwan Jo, Hoon Yang
Journal of the Korean Fracture Society.2010; 23(2): 180. CrossRef

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Penetration of Joints by Screws on Anterior Process of Calcaenus: Choong Hyeok Choi, Il Hoon Sung, Bong Geun Lee, Doo Jin Paik, Dong Won Kim; J Korean Fract Soc 2004;17(3):257-260. Published online July 31, 2004; DOI: https://doi.org/10.12671/jkfs.2004.17.3.257

Abstract PDF: PURPOSE
This study was performed to determine the involvement of joints by screws, inserted on the anterior process of the calcaneus, using cadaveric specimens.
MATERIALS AND METHODS
An L-shaped lateral incision was performed on 32 embalmed feet (16 cadavers). An H-plate was applied on lateral wall of the calcaneus and it's anterior margin was located at 4 mm posterior to the lateral margin of the calcaneocuboidal joint. 3.5 mm cortical screws were inserted perpendicularly to the lateral calcaneal wall through the plate. Each calcaneus was dissected and taken out from the foot, and whether the tips of screws penetrated joints on the anterior process was evaluated.
RESULTS
11 (17.2%) of 64 screws, inserted on the anterior process, penetrated joints. Among them, seven screws involved the calcaneocuboidal joint and four screws penetrated the anterior facet of the subtalar joint. In two cases, both joints were penetrated by screws.
CONCLUSION
This study shows that joint surfaces could be penetrated by screws inserted from the lateral surface on the anterior process of the calcaneus. Care should be given to selecting the length and insertional angle of screws. Intraoperative radiography would be needed to observe the articular surface on the anterior process, when screws were inserted to the anterior process close to the calcaneocuboidal joint.

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Anterolateral Approach for the Distal Metaphyseal Fracture of the Tibia: Taek Soo Jeon, Jae Woo Lim, Whan Yong Chung, Woo Suk Lee, Woo Sik Kim, Cheol Mog Hwang, Yong Chan Kim, Nam Hyun Kim, Yong Sang Kim, Sung Kwan Jo; J Korean Fract Soc 2004;17(3):243-248. Published online July 31, 2004; DOI: https://doi.org/10.12671/jkfs.2004.17.3.243

Abstract PDF: PURPOSE
The purpose of this study is to evaluate the effectiveness of anterolateral approach of the ankle for the distal tibial fracture in aspect of preventing complication and acquiring union.
MATERIALS AND METHODS
Authors reviewed 21 patients of distal metaphyseal fracture of the tibia treated by anterolateral approach and lateral plating method from February, 2000 to May, 2002. Mean follow-up period was 17 months (12~29 months). There were twelve type A, two type B, and four type C patients according to AO/OTA classification. We have analyzed the bone union rate and Ovadia`s functional scale. We also reviewed the complication rate, such as soft tissue problem and postoperative infection.
RESULTS
In all cases union was achieved and mean time to union were 16 weeks. The functional result by Ovadia's scale were 17 excellent cases and 4 good cases in objective evaluation, and 19 excellent cases and 2 good cases in subjective evaluation. Wound infection occurred in one case, but the infection was controlled after plate removal and the union was acquired through cast immobilization. There was no other complication, such as soft tissue necrosis.
CONCLUSION
The anterolateral approach is a safe and worthwhile method for distal tibia fracture while avoiding some of the complication associated with standard anteromedial approach and plating method.

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Lateral Approach for Internal Fixation of the Distal Humeral Shaft Fractures: Seung Koo Rhee, Joo Yup Lee, Yoo Joon Suh, Joon Ho Lee, Nong Kyoum Ahn; J Korean Fract Soc 2004;17(2):83-89. Published online April 30, 2004; DOI: https://doi.org/10.12671/jkfs.2004.17.2.83

Abstract PDF

PURPOSE
To investigate the efficacy and advantages of the lateral approach for internal fixation of the distal humeral shaft fractures.
MATERIALS AND METHODS
Twelve patients with distal humeral shaft fractures who underwent open reduction and internal fixation using plate and screws by lateral approach from January, 1997 to May, 2002 were investigated. Postoperative results after a minimum 1 year follow-up were assessed using union rate, elapsed time to union, postoperative complications such as iatrogenic radial nerve palsy, range of motion of the elbow joint. Clinical outcomes were evaluated with Mayo elbow performance scoring system.
RESULTS
Union was achieved in all cases. The average time to union was 9 weeks (range, 7~12 weeks). Four cases of preoperative radial nerve palsy were revealed as contusion of the intact nerve and resolved completely by three months. The mean elbow range of motion was from 5 to 138 degrees. The average Mayo elbow performance score was 91 points; 9 cases ranked as excellent and 3 as good.
CONCLUSION
Distal humeral shaft fractures can be treated successfully through open reduction and internal fixation using plate and screws. Lateral approach is recommended to stabilize distal humeral shaft fractures without compromising the range of motion of the elbow, and to protect or explore the injured radial nerves easily

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Modified anterolateral approach for internal fixation of Holstein–Lewis humeral shaft fractures
Ho Min Lee, Young Sung Kim, Suk Kang, Min Young Lee, Jong Pil Kim
Journal of Orthopaedic Science.2018; 23(1): 137. CrossRef
Posterior Dual Plating for Distal Shaft Fractures of the Humerus
Chul-Hyun Cho, Kwang-Yeung Jeong, Beom-Soo Kim
Journal of the Korean Fracture Society.2017; 30(3): 117. CrossRef

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Open Reduction using Lateral Approach in Displaced Intra-articular Fracture of Calcaneus: Kyung Jin Song, Keun Ho Yang, Joo Hong Lee; J Korean Soc Fract 2002;15(4):446-454. Published online October 31, 2002; DOI: https://doi.org/10.12671/jksf.2002.15.4.446

Abstract PDF: PURPOSE
This study was designed to investigate the usefulness of lateral approach for accurate reduction and rigid internal fixation in comminuted intra-articular fractures of calcaneus.
MATERIALS AND METHOD
Twenty patients(21 cases) who had intra-articular fracture of calcaneus and underwent an open reduction and internal fixation using lateral approach were enrolled. Using Essex-Lopresti classification, all cases were intra-articular fracture, which joint depression type was 17 cases and 4 of severe comminuted tongue type. We compared the preoperative and postoperative change of B o h l e r 's angle and clinical results were analyzed using Paley and Halls evaluation protocol and scoring system.
RESULTS
The average B ohler 's angle was restored from 2.8 to 25.1 after operations and clinical results classified 4 well, 12 good, 4 fair, 1 poor cases. Postoperative complications were 2 cases of wound dehiscence, 1 of infection and one had sural nerve injury. Late complications included 3 cases of limitation of motion of ankle that disturb usual activity, 3 of sustained pain and 2 of traumatic arthritis and 2 cases had 2 complications at the same patients.
CONCLUSION
The lateral approach is valuable for the comminuted intra-articular fractures of calcaneus that enables accurate anatomical reduction and rigid internal fixation by providing direct exposure of subtalar joint, and also with little morbidity of neurovascular injury.

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Operative Treatment of Intraarticular Calcaneus Fractures with extensile lateral approach: Dong Kyu Shin, Yong Woon Kim; J Korean Soc Fract 2001;14(3):440-449. Published online July 31, 2001; DOI: https://doi.org/10.12671/jksf.2001.14.3.440

Abstract PDF: PURPOSE
Through the analysing intraarticular calcaneal fractures operated with extensile lateal approach and lateral plate fixation we tried to find the factors related to the result and to prove the usefulness of this treatment method. MATERIAL AND METHOD: We reviewed 50 intraarticular calcaneal fractures which were treated with this method between July 1995 and December 1998. We analysed the relationship between the fracture type and the accuracy of posterior facet reduction and between the accuracy of reduction and the clinical result. We also analysed the complication rate.
RESULT
We gained anatomical reduction in 64% among all cases. There was significant relationship statistically between the Sanders fracture type and accuracy of reduction(p=0.001). There were also significant relationship statistically between the Sanders fractrure type and the clinical result(p=0.045) and between the accuracy of reduction and clinical result(p=0.001). It was also possible to regain the calcaneal height, width and Bohler angle through this treatment method. There was only one wound complication which was skin necrosis and was treated with dressing and finally skin graft.
CONCLUSION
Sanders classification was very useful and reasonable for this kind of fracture. The accuracy of reduction of posterior facet was very important to clinical result. This treatment method for the calcaneal fracture was useful in the term of regain of anatomical components of calcaneus such as posterior facet congruency, calcaenal height, width and Bohler angle with acceptable rate of serious complication.

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Result of Surgical Treatment of Calcaneal Fractures Using Extensile Lateral Approach: Sung Do Cho, Yong Sun Cho, Bum Soo Kim, Tae Woo Park, Gi Bong Kim, Key Yong Kim; J Korean Soc Fract 1999;12(2):320-327. Published online April 30, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.2.320

Abstract PDF

Thirty-eight calcaneal fractures were treated with open reduction and internal fixation using extensile lateral approach from Jun. 1993 to Dec. 1996 and were followed more than a year. According to the Essex-Lopresti classification, there were 28 cases of joint depression type and 10 cases of tongue type. According to the Sanders classification, there were 20 cases of type II, 13 cases of type III and 5 cases of type IV. The purpose of this study is to analyze the results of surgical treatment of calcaneal fractures using extensile lateral approach and its complications. The results were as follows; 1. B.. ohler angle was improved from -2.4degrees to 20.5degrees and Gissane angle was improved from 114.5degrees to 120.4degreesafter the operation. The height of the calcaneus was improved from 75% to 95% and the width of the calcaneus was reduced from 119% to 106% of contralateral side. 2. yThe postoperative reduction status of the articular surface was analyzed by computed tomography(CT) in 18 patients and was found to be less than 2 mm of step-off in 10 cases, between 2 and 5 mm in 7 cases and more than 5 mm in 1 case. 3. Based on the assessment criteria of Salama et al., the functional results were excellent in 10 cases, good in 14 cases, fair in 10 cases, and poor in 4 cases. Unsatisfactory results were correlated with severity of articular comminution and failure to obtain accurate reduction of the articular surface. 4. Fourteen cases (36.8%), developed postoperative complications such as heel pain, causalgia and numbness, subtalar arthritis, marginal necrosis of wound, lateral subfibular impingement and heel bulging. In conclusion, Because of high incidence of postoperative complications, careful and meticulous exposure technique in doing extensile lateral approach are necessary for a satisfactory outcomes.

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Treatment of Intra-articular Calcaneal Fractures Using Minimally Invasive Sinus Tarsi Approach in Diabetic Patients
Hong-Moon Sohn, Sang-Ho Ha, Sang-Hong Lee, Jun-Young Lee, Jeong-Ho Kim, Sang-Jun Lee
Journal of the Korean Fracture Society.2008; 21(3): 195. CrossRef

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Intra-Articular Fractures of the Calcaneus: Open reduction and internal fixation via extended lateral transcalcaneal approach: Chung Soo Hwang, Phil Hyun Chung, Suk Kang, Yong Min Kim, Hyung Ho Oh, Dong Joo Chae, Min Hyo Park, Jee Hong Kim, Yun Chul Cho; J Korean Soc Fract 1996;9(3):733-741. Published online July 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.3.733

Abstract PDF: Fractures with displaced articular facet of subtalar joint occupies 60-75% of whole calcaneal fractures. Nowadays, general principle of treatment for displaced intraarticular fracture has become anatomical reduction of joint surface and rigid fixation of the fracture. However, it had been difficult to apply this principle in cases of calcaneus due to various obstacles such as anatomical characteristics, therefore outcomes were not satisfactory in many cases. Extended lateral approach, which was designed by Letournel and Benirschke, contributed greatly in overcoming those obstacles. From August 1992 to April 1994, the author managed fifteen displaced intraarticular fractures of the calcaneus in fourteen patients with open reduction of displaced intraarticular fragment via extended lateral approach and internal fixation using reconstruction plate. The fractures were examined preoperatively with Brodens view and classified according to Eastwood(1992) with 2-plane CT. All the fractures united within postoperative 20 weeks(average 10.9 weeks). Final results were assessed by the clinical criteria for calcaneal fracture designed in Greighton Nebraska Health Foundation. Among the 15 cases, excellent results were obtained in eight cases, good in six, fair in one. There were no remarkable complications at the latest follow-up. In managing displaced intraarticular fractures of calcaneus, open reduction of displaced intraarticular fragment via extended lateral approach and internal fixation using reconstruction plate seemed to be very useful and harmless method.

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Operative Treatment of Calcaneal Fracture: Jeong Ho Park, Young Min Yoon, Young Gi Hong, Jeong Whan Son, Jae Do Kim; J Korean Soc Fract 1996;9(2):363-368. Published online April 30, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.2.363

Abstract PDF: In the past, the treatment of calcaneal fracture was mainly non-operative, because of its unique shape, difficulties arose in understanding the pathoanantomy of the fractures. Following to advancement in imaging techinique including CT scan, which became to evaluate fracture patterns of the calcaneal fracture more accurately, the operative treatment has been popularized. The extensive lateral approach for intra-articular calcaneal fracture which was reported by Letournel in 1988, provides sufficent exposure of calcaneus and allows the easier reduction, rigid fixation and early mobilization. The 11 tases of 10 patients of intra-articular fractures of calcaneus were treated with open reduction and internal fixation through extensive laterai approach form Jan.1992 to Dec. 1994. The satisfactory result were observed in 8 cases(73%) by Stephenson criteria. It was concluded that operativa treatment will be better to the intra-articula fracture of the calcaneus than the conservative treatment.

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Surgical Treatment of Intra-articular Fracture of the Os Calcis: Soo Kil Kim, Young Gyu Kim, Bum Gu Lee, Jin Hong Ko, Su Chan Lee, Young Kim; J Korean Soc Fract 1996;9(2):354-365. Published online April 30, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.2.354

Abstract PDF: Intra-articular fractures involving the posterior facet of the subtalar joint are associated with significant and prolonged disability. But, the treatment of choice for displaced intra-articular calcaneal fractures remains controversial. We treated 30 displaced intra-articular fractures of the calcaneus by open 1eduction and internal fixation through the lateral approach with autogenous bone graft at the Department of Orthopaedic Surgery, Choong-ang Gil and Dong Inchon Gil Ceneral Hospital from January 1990 to October 1994 The clinical and radiographic analyses were as follows. 1. Of 26 patients, 20 patients were male and 6 patients were female. 2. The main cause fractures of calcaneus was a fall from a height in 23 cases(88%) and most of associ ated fractures were spine injury in 6 patients. 3. Fracture was classified according to Essex-Lopresti classification. 13 cases were tongue type, 17 cases were joint depression type. 4. Alt Open reduction and internal fixation through the laterl approach with bone graft was performed in joint depression type and tongue type. 5. The preoperative ayerage Bohlers angle was - 5. The postoperative avereage Bohlers angle was -24, Which was increased significantly. 6. Complications were 12 cases ; included heel pad pain in 8 caLes, osteomyelitis and superficial wound infection in 2 cases, transient sensory hypesthesia on the lateral side of the foot in 2 cases. 7. Based on assessement of Salama, the results were excellent in 5 cases, good in 1 Teases, fair in 6 cases, poor in 2 cases.

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Intra-Articular Fractures of the Calcaneus: ORIF via Lateral Approac: Ik Dong Kim, Jo Chul Ihn, Poong Taek Kim, Byung Chul Park, Young Goo Lyu, Il Hyung Park, Sung Jung Kim; J Korean Soc Fract 1992;5(2):199-204. Published online November 30, 1992; DOI: https://doi.org/10.12671/jksf.1992.5.2.199

Abstract PDF: The os calcis is one of the most commonly injured tarsal bone and fractures involving the subtalar joint may cause serious and persistent disabilities. We treated 12 intra-artlcular calcaneal fractures in 11 patients from June, 1998 to April, 1992 by plate fixation after lateral approach. The Sanders fracture classification system was applied to out study which classify the fractures according to the number of the fractured segments and direction of the fracture lines after computerized axial tomography of the posterior facetal joint. The follow-up evaluation included questioning the patient about pain during activity and rest, the ability to walk and stand, range of subtalar motion and ability to return to work according to the assessment sheet for calcaneal fractures of Creighton Nebraska Health Foundationl We experienced 8 excellent and 2 good results among 12 cases and there was little complication.

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